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BACKGROUND: Chronic hepatitis C(CHC) staging is important for therapeutic decision-making. Identification of noninvasive markers can provide alternatives to liver biopsy. AIM: To assess the value of APRI and FIB4 for CHC fibrosis staging in a cohort of nonselected outpatients from a referral center in Sao Paulo, Brazil. MATERIAL AND METHODS: Medical records of 798 adult outpatients were analyzed retrospectively. For calculations of APRI and FIB4, the original descriptions were considered, and markers were compared with degree of liver injury. RESULTS: Overall, 49.3% of participants were female, and mean age was 56.9 ± 12.5 years. Genotype 1 was predominant (71.7 vs. 23.7% genotype 3); 64% had significant fibrosis, 44% had advanced fibrosis, and 28% had cirrhosis. The areas under the receiver operating curve for significant fibrosis, advanced fibrosis, and cirrhosis, respectively, were 0.809, 0.819, and 0.815 for the APRI marker and 0.803, 0.836 and 0.852 for FIB4. Using the recommended cut off values, approximately 30-40% of the patients could not be classified. In the remainder, either APRI or FIB4 alone correctly diagnosed 80-85% of cases. Concomitant or consecutive use of both APRI and FIB4 increased the number of the cases correctly diagnosed only slightly, but also increased the number of patients not classified within the cutoff values. CONCLUSIONS: In conclusion, use of the APRI or FIB4 markers for detection of hepatic fibrosis may be a viable alternative at referral centers for treatment of CHC in low- and middle-income countries. Despite relatively good accuracy, a significant number of patients could not be assessed by these methods.
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Pruebas Enzimáticas Clínicas , Técnicas de Apoyo para la Decisión , Hepatitis C Crónica/diagnóstico , Cirrosis Hepática/diagnóstico , Pacientes Ambulatorios , Recuento de Plaquetas , Adulto , Factores de Edad , Anciano , Alanina Transaminasa/sangre , Área Bajo la Curva , Aspartato Aminotransferasas/sangre , Biomarcadores/sangre , Brasil , Femenino , Hepatitis C Crónica/sangre , Hepatitis C Crónica/complicaciones , Humanos , Cirrosis Hepática/sangre , Cirrosis Hepática/virología , Masculino , Persona de Mediana Edad , Modelos Biológicos , Valor Predictivo de las Pruebas , Pronóstico , Curva ROC , Reproducibilidad de los Resultados , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
INTRODUCTION: A large number of patients with chronic hepatitis C have not been cured with interferon-based therapy. Therefore, we evaluated the efficacy of amantadine combined with the standard of care(pegylated interferon plus ribavirin) in patients who had not responded to or had relapsed after ≥ 24 weeks of treatment with conventional interferon plus ribavirin. MATERIAL AND METHODS: Patients stratified by previous response (i.e., non-response or relapse) were randomized to 48 weeks of open-label treatment with peginterferon alfa-2a (40KD) 180 µg/week plus ribavirin 1,000/1,200 mg/day plus amantadine 200 mg/day (triple therapy), or the standard of care (peginterferon alfa-2a [40KD] plus ribavirin). RESULTS: The primary outcome was sustained virological response (SVR), defined as undetectable hepatitis C virus RNA in serum (< 50 IU/mL) at end of follow-up (week 72). Among patients with a previous non-response, 12/53 (22.6%; 95% confidence interval [CI] 12.3-36.2%) randomized to triple therapy achieved an SVR compared with 16/52 (30.8%; 95% CI 18.7-45.1%) randomized to the standard of care. Among patients with a previous relapse 22/39 (56.4%; 95% CI 39.6-72.2%) randomized to triple therapy achieved an SVR compared with 23/38 (60.5%; 95% CI 43.4-76.0%) randomized to the standard of care. Undetectable HCV RNA (< 50 IU/mL) at week 12 had a high positive predictive value for SVR. A substantial proportion of non-responders and relapsers to conventional interferon plus ribavirin achieve an SVR when re-treated with peginterferon alfa-2a (40KD) plus ribavirin. CONCLUSION: Amantadine does not enhance SVR rates in previously treated patients with chronic hepatitis C and cannot be recommended in this setting.
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Amantadina/uso terapéutico , Antivirales/uso terapéutico , Farmacorresistencia Viral , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/uso terapéutico , Polietilenglicoles/uso terapéutico , Ribavirina/uso terapéutico , Adulto , Amantadina/efectos adversos , Antivirales/efectos adversos , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Hepacivirus/genética , Hepatitis C Crónica/sangre , Hepatitis C Crónica/prevención & control , Humanos , Interferón-alfa/efectos adversos , Masculino , Persona de Mediana Edad , Polietilenglicoles/efectos adversos , ARN Viral/sangre , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/uso terapéutico , Ribavirina/efectos adversos , Prevención Secundaria , Resultado del TratamientoRESUMEN
BACKGROUND: There is limited knowledge about the risk of non-alcoholic fatty liver disease (NAFLD) associated with cardiometabolic disorders in lean persons. This study examines the contribution of cardiometabolic disorders to NAFLD risk among lean individuals and compares to non-lean individuals. METHODS: We analyzed longitudinal data from 6,513 participants of a yearly voluntary routine health testing conducted at the Hospital Israelita Albert Einstein, Brazil. NAFLD was defined as hepatic ultrasound diagnosed fatty liver in individuals scoring below 8 on the alcohol use disorders identification test. Our main exposure variables were elevated blood glucose, elevated blood pressure (BP), presence of atherogenic dyslipidemia (AD, defined as the combination of elevated triglycerides and low HDL cholesterol) and physical inactivity (<150 minutes/week of moderate activity). We further assessed the risk of NAFLD with elevations in waist circumference and high sensitivity C-reactive protein (HsCRP). RESULTS: Over 15,580 person-years (PY) of follow-up, the incidence rate of NAFLD was 7.7 per 100 PY. In multivariate analysis adjusting for likely confounders, AD was associated with a 72% greater risk of NAFLD (IRR: 1.72 [95% CI:1.32-2.23]). Elevated blood glucose (IRR: 1.71 [95%CI: 1.29-2.28]) and physical inactivity (IRR: 1.46 [95%CI: 1.28-1.66]) were also independently associated with increased risk of NAFLD. In lean individuals, AD, elevated blood glucose and elevated BP were significantly associated with NAFLD although for elevated blood glucose, statistical significance was lost after adjusting for possible confounders. Physical inactivity and elevations in HsCRP were not associated with the risk of NAFLD in lean individuals only. Among lean (and non-lean) individuals, there was an independent association between progressively increasing waist circumference and NAFLD. CONCLUSION: Cardiometabolic risk factors are independently associated with NAFLD. However, there are significant differences in the metabolic risk predictors of NAFLD between lean and non-lean individuals. Personalized cardiovascular disease risk stratification and appropriate preventive measures should be considered in both lean and non-lean individuals to prevent the development of NAFLD.
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Alcoholismo , Hipertensión , Enfermedad del Hígado Graso no Alcohólico , Alcoholismo/complicaciones , Glucemia , Índice de Masa Corporal , Proteína C-Reactiva , Humanos , Hipertensión/complicaciones , Incidencia , Inflamación/complicaciones , Estudios Longitudinales , Enfermedad del Hígado Graso no Alcohólico/metabolismo , Factores de RiesgoRESUMEN
BACKGROUND: The epidemiology and clinical characteristics of nonalcoholic fatty liver disease (NAFLD) in South America are not well known. Brazil is a largest country in this part of the world and the present study aimed to contribute with this information. METHODS: This descriptive study included patients from medical centers around Brazil, who had diagnosis of NAFLD. They were selected from chart review and also prospectively in Hepatology out-clinics. Patients with history of alcohol intake and others liver diseases were excluded. Histological diagnosis included: steatosis or steatohepatitis (steatosis, ballooning of hepatocytes or fibrosis). The criteria to perform a liver biopsy was ALT or AST > 1.5 x normal levels. RESULTS: A total of 1280 patients from 16 Brazilian centers and all five regions were included. The mean age was 49.68 ± 13.59 years; 53.3% were males and 85% were asymptomatic. Hyperlipidemia was observed in 66.8% cases, obesity in 44.7%, overweight in 44.4%, diabetes in 22.7%, and toxins exposure in 10%. Metabolic syndrome was observed in 41.3% cases. Elevated levels of ALT, AST and GGT were observed in 55.8%, 42.2% and 63.1% cases, respectively. Liver biopsy performed in 437 cases showed: isolate steatosis in 42% cases, steatohepatitis in 58% and 27% of them also presented fibrosis. Cirrhosis was observed in 15.4% and hepatocellular carcinoma in 0.7%. CONCLUSIONS: NAFLD in Brazil is more frequent in asymptomatic males; steatohepatitis with fibrosis and cirrhosis were a significant diagnosis. The genetic predisposition and lifestyle should be influenced in the spectrum; however these findings deserve a future investigation.
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Hígado/patología , Adulto , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Biopsia , Brasil/epidemiología , Carcinoma Hepatocelular/epidemiología , Carcinoma Hepatocelular/patología , Pruebas Enzimáticas Clínicas , Hígado Graso/diagnóstico , Hígado Graso/epidemiología , Hígado Graso/patología , Femenino , Humanos , Hígado/enzimología , Cirrosis Hepática/epidemiología , Cirrosis Hepática/patología , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico , Estudios Prospectivos , Estudios Retrospectivos , gamma-Glutamiltransferasa/sangreRESUMEN
BACKGROUND: Recent studies suggest that non-alcoholic fatty liver disease (NAFLD) in lean (BMI<25 âkg/m2) individuals presents a distinct phenotype. We sought to determine the cardiometabolic consequences of lean NAFLD in a population cohort of relatively young asymptomatic individuals who participated in a voluntary routine health promotion evaluation in Brazil. METHODS: We analyzed data in our population collected from 2004 to 2016. Medical and demographic history, anthropometric measures, and fasting blood samples were obtained. Participants had ultrasonography to assess for fatty liver. We defined NAFLD as fatty liver in individuals scoring below 8 on the alcohol use disorders identification test (AUDIT). We included data from 9137 individuals who had complete data at baseline and at follow-up. RESULTS: The prevalence of lean NAFLD in our cohort was 3.8%. Over the median follow-up period of 2.4 years (range 0.5-9.9 years), lean individuals had 74% (HR: 1.74 (1.39-2.18)) and 67% (1.67 (1.29-2.15)) greater risk of developing elevated BP and elevated glucose, and nearly 3 times the risk of atherogenic dyslipidemia (HR: 2.98 (2.10-4.24)) compared to lean individuals without NAFLD. Lean NAFLD individuals also had higher risk of developing elevated glucose (HR: 1.37 (1.07-1.75)) and atherogenic dyslipidemia (1.46 (1.05-2.01)) compared to non-lean individuals without NAFLD. However, there was no significant difference in the risk of elevated BP, elevated glucose or atherogenic dyslipidemia between lean NAFLD and non-lean individuals with NAFLD in fully adjusted models. CONCLUSION: Lean NAFLD is not metabolically benign. Further cardiovascular risk stratification and appropriate preventive measures should be considered in lean individuals who present with NAFLD.
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Antivirales/uso terapéutico , Hepacivirus/efectos de los fármacos , Hepatitis C Crónica/tratamiento farmacológico , Antivirales/efectos adversos , Coinfección , Consenso , Interacciones Farmacológicas , Quimioterapia Combinada , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Hepacivirus/patogenicidad , Hepatitis B/diagnóstico , Hepatitis B/tratamiento farmacológico , Hepatitis B/epidemiología , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/epidemiología , Humanos , América Latina/epidemiología , Trasplante de Hígado/efectos adversos , Recurrencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Activación Viral/efectos de los fármacosRESUMEN
The prevalence of obesity-related metabolic syndrome has rapidly increased in Brazil, resulting in a high frequency of nonalcoholic fatty liver disease, that didn't receive much attention in the past. However, it has received increased attention since this disease was identified to progress to end-stage liver diseases, such as cirrhosis and hepatocellular carcinoma. Clinical practice guidelines for the diagnosis and treatment of nonalcoholic fatty liver disease have not been established in Brazil. The Brazilian Society of Hepatology held an event with specialists' members from all over Brazil with the purpose of producing guideline for Nonalcoholic Fatty Liver Disease based on a systematic approach that reflects evidence-based medicine and expert opinions. The guideline discussed the following subjects: 1-Concepts and recommendations; 2-Diagnosis; 3-Non-medical treatment; 4-Medical treatment; 5-Pediatrics - Diagnosis; 6-Pediatrics - Non-medical treatment; 7-Pediatrics - Medical treatment; 8-Surgical treatment.
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Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Enfermedad del Hígado Graso no Alcohólico/terapia , Brasil , Consenso , Medicina Basada en la Evidencia , Humanos , Sociedades MédicasRESUMEN
Hepatocellular carcinoma is a malignancy of global importance and is associated with a high rate of mortality. Recent advances in the diagnosis and treatment of this disease make it imperative to update the recommendations on the management of the disease. In order to draw evidence-based recommendations concering the diagnosis and management of hepatocellular carcinoma, the Brazilian Society of Hepatology has sponsored a single-topic meeting in João Pessoa (PB). All the invited pannelists were asked to make a systematic review of the literature and to present topics related to the risk factors for its development, methods of screening, radiological diagnosis, staging systems, curative and palliative treatments and hepatocellular carcinoma in noncirrhotic liver. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of those recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present paper is the final version of the reviewed manuscript containing the recommendations of the Brazilian Society of Hepatology.
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Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/terapia , Sociedades Médicas , Brasil , HumanosRESUMEN
BACKGROUND AND AIMS: The combination of pegylated interferon alfa/ribavirin will likely remain the treatment of choice for HCV genotype 2/3 patients in financially constrained countries for the foreseeable future. Patients with poor on-treatment response may benefit from treatment extension. This study examined the effect of 48 versus 24 weeks of peginterferon alfa-2a/ribavirin on the sustained virological response (SVR) in patients with HCV genotype 2/3 who did not achieve rapid virological response (RVR). METHODS: N-CORE was a multicentre, randomised, phase III study. HCV genotype 2/3 patients receiving peginterferon alfa-2a/ribavirin without a rapid but with an early virological response were randomised at week 24 to stop treatment (Arm A) or continue to 48 weeks (Arm B). The primary efficacy endpoint was SVR. RESULTS: Two hundred thirty-five patients were enrolled. End of treatment response was similar in both treatment arms. SVR24 rates were not significantly greater in the extended treatment arm compared with the standard 24-week treatment in either the intention-to-treat or the per-protocol populations (61 vs. 52 %, p = 0.1934 and 63 vs. 52 %, p = 0.1461, respectively). Serious adverse events occurred more frequently in patients receiving extended treatment duration (12 %) versus 24-week therapy (4 %). CONCLUSIONS: It is unclear whether the extension of peginterferon alfa-2a/ribavirin treatment may benefit HCV genotype 2/3 patients who do not achieve RVR. The study was stopped early because recruitment was slower than anticipated, and this may have limited the statistical impact of these findings.
RESUMEN
ABSTRACT The prevalence of obesity-related metabolic syndrome has rapidly increased in Brazil, resulting in a high frequency of nonalcoholic fatty liver disease, that didn't receive much attention in the past. However, it has received increased attention since this disease was identified to progress to end-stage liver diseases, such as cirrhosis and hepatocellular carcinoma. Clinical practice guidelines for the diagnosis and treatment of nonalcoholic fatty liver disease have not been established in Brazil. The Brazilian Society of Hepatology held an event with specialists' members from all over Brazil with the purpose of producing guideline for Nonalcoholic Fatty Liver Disease based on a systematic approach that reflects evidence-based medicine and expert opinions. The guideline discussed the following subjects: 1-Concepts and recommendations; 2-Diagnosis; 3-Non-medical treatment; 4-Medical treatment; 5-Pediatrics - Diagnosis; 6-Pediatrics - Non-medical treatment; 7-Pediatrics - Medical treatment; 8-Surgical treatment.
RESUMO A prevalência de obesidade relacionada à síndrome metabólica tem crescido no Brasil, que implicou em uma maior frequência de doença hepática gordurosa não alcoólica, não havia recebido muita atenção no passado. Contudo, essa atenção tem merecido interesse cada vez maior desde que se observou o elevado potencial de progressão para formas mais graves dessa doença como cirrose e carcinoma hepatocelular. No Brasil ainda não havia sido proposta nenhuma diretriz para orientar o diagnóstico e tratamento da doença hepática gordurosa não alcoólica. A Sociedade Brasileira de Hepatologia realizou então um evento que reuniu especialistas de todo o Brasil com o objetivo de propor uma diretriz para a doença hepática gordurosa não alcoólica baseada em evidências científicas e opiniões de especialistas nesse tema. A diretriz final é composta dos seguintes temas: 1-Conceitos e recomendações; 2-Diagnóstico; 3-Tratamento não medicamentoso; 4-Tratamento medicamentoso; 5-Diagnóstico em Pediatria; 6-Tratamento não medicamentoso em Pediatria; 7-Tratamento medicamentoso em Pediatria; 8-Tratamento cirúrgico.
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Humanos , Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Enfermedad del Hígado Graso no Alcohólico/terapia , Sociedades Médicas , Brasil , Medicina Basada en la Evidencia , ConsensoRESUMEN
ABSTRACT Hepatocellular carcinoma is a malignancy of global importance and is associated with a high rate of mortality. Recent advances in the diagnosis and treatment of this disease make it imperative to update the recommendations on the management of the disease. In order to draw evidence-based recommendations concering the diagnosis and management of hepatocellular carcinoma, the Brazilian Society of Hepatology has sponsored a single-topic meeting in João Pessoa (PB). All the invited pannelists were asked to make a systematic review of the literature and to present topics related to the risk factors for its development, methods of screening, radiological diagnosis, staging systems, curative and palliative treatments and hepatocellular carcinoma in noncirrhotic liver. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of those recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present paper is the final version of the reviewed manuscript containing the recommendations of the Brazilian Society of Hepatology.
RESUMO O carcinoma hepatocelular é uma neoplasia de importância global e associada a altos índices de mortalidade. Recentes avanços no diagnóstico e tratamento da doença tornaram necessárias que se atualizassem as recomendações sobre o manejo da doença. Para definir as recomendações sobre o diagnóstico e tratamento do carcinoma hepatocelular, a Sociedade Brasileira de Hepatologia organizou uma reunião monotemática em João Pessoa (PB). Todos expositores foram solicitados a fazer uma revisão sistemática da literatura e apresentar os temas relacionados a fatores de risco para o desenvolvimento de carcinoma hepatocelular, métodos para rastreamento, diagnóstico radiológico e sistemas de estadiamento da doença, tratamentos curativos e paliativos e carcinoma hepatocelular em fígado não cirrótico. Após o encontro, todos os expositores se reuniram para discussão dos tópico e elaboração dessas recomendações. O texto resultante foi ainda submetido a avaliação e aprovação por todos membros da Sociedade através de sua homepage. O documento atual é a versão final que contêm as recomendações da Sociedade Brasileira de Hepatologia.
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Humanos , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/terapia , Sociedades Médicas , BrasilRESUMEN
BACKGROUND: Modifications of oxidative stress are reported in hepatitis C. The relationship between insulin resistance (IR), steatosis and oxidative stress is not established. MATERIALS AND METHODS: One hundred and eighty-seven HCV-RNA patients were assessed by determination of biochemical, metabolic and viral features, HOMA-IR and morphological alterations. In the 52-non-3 genotypes sub-group and 35 healthy individuals, thiobarbituric acid (TBARS), total glutathione (total-GSH), vitamins C and E, lycopene, beta-carotene, glutathione peroxidase (GPx), catalase and superoxide dismutase were determined. RESULTS: In non-3 genotype patients, steatosis was associated with higher values of BMI, HOMA-IR and triglycerides. In the 52-HCV sub-group, values of TBARS, GPx and total-GSH differ from the control group. Despite these, differences could not be observed according to the presence of steatosis, patients with IR presented significant differences regarding total-GSH (p=0.019), beta-carotene (p=0.006), lycopene (p=0.005) and GPx (p=0.009). CONCLUSION: In non-3 genotype HCV carries, IR, and not steatosis, is associated with modifications in serum levels of oxidative stress.
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Hepacivirus/fisiología , Hepatitis C Crónica/sangre , Resistencia a la Insulina , Estrés Oxidativo , Adolescente , Adulto , Anciano , Biomarcadores/sangre , Hígado Graso/sangre , Femenino , Genotipo , Hepacivirus/genética , Hepatitis C Crónica/virología , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
AIM: Several noninvasive markers are being used to assess the structural liver damage in patients with chronic hepatitis C (CHC). We evaluated the capacity of serum hyaluronic acid (HA), aspartate aminotransferase (AST)/ALT ratio, the AST to platelet ratio index (APRI) and gamma-glutamyltransferase (GGT) levels to predict the intensity of hepatic fibrosis in patients with CHC. PATIENTS AND METHODS: In a total of 206 hepatitis C virus RNA-positive biopsied patients, AST, ALT, GGT levels, platelet count and serum HA concentration were determined. The APRI was calculated as the ratio of AST to platelets. RESULTS: HA levels were best correlated with disease stage (r=-0.694; P<0.001). In the diagnosis of significant fibrosis (F2-F4), HA levels [AUC=0.879, 95% CI (0.832-0.927)] and APRI [AUC=0.824 (0.772-0.903)] were the markers with the best diagnostic accuracy. These parameters also best identified the presence of cirrhosis (F4), with an AUC of 0.908 (0.868-0.949) for HA and of 0.837 (0.772-0.903) for APRI. CONCLUSION: Serum HA was the parameter that alone presented the best diagnostic accuracy in the assessment of hepatic fibrosis in CHC. The APRI showed a better diagnostic sensitivity than GGT levels or the AST/ALT ratio. Its simple determination and low cost make this index a valid alternative for the noninvasive staging of CHC.
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Biomarcadores/sangre , Hepatitis C Crónica/sangre , Hepatitis C Crónica/complicaciones , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/virología , Adulto , Anciano , Alanina Transaminasa/sangre , Área Bajo la Curva , Aspartato Aminotransferasas/sangre , Femenino , Humanos , Ácido Hialurónico/sangre , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Valor Predictivo de las Pruebas , Estudios Prospectivos , gamma-Glutamiltransferasa/sangreRESUMEN
Dez voluntários adultos, cinco homens e cinco mulheres, realizaram teste respiratório com 13C-metacetina, antes e após a ingestão de 0,3ml/kg de etanol. A 13C-metacetina foi administrada na dose de 2mg/kg de peso e sua concetração no ar expirado foi medida através de espectrometria infravermelha não dispersiva, durante duas horas em inetervalos de dez minutos. Após a injestão aguda de álcool, os valores da metabolização da 13C-metacetina foram estatisticamente inferiores aos observados antes de sua ingestão emtodos os dez voluntários testados, para todos os parâmetros analisados (dose acumulada aos 120 minutos 29,3ñ4,4por cento antes e 21,2 ñ 4,8por cento após etanol, p<0,001). Essa redução foi mais acentuada nos voluntários do sexo feminino nos primeiros 20 minutos do teste, havendo diferenças significantes em relação aos do sexo masculino. Esses resultados demonstram que o estresse oxidativo produzido pelo etanol é capaz de alterar significantemente a metabolização de 13C-metacetina, pelo fígado humano, especialmente nas mulheres, e evidenciam o papel dos microssomas hepáticos na oxidação da metacetina e a possibilidade de interferencia da ingestão de etanol sobre a sensibilidade do teste GED 19(6):245-248,2000
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Humanos , Masculino , Femenino , Adulto , Pruebas Respiratorias , Isótopos de Carbono , Pruebas de Función Hepática , Estrés Oxidativo , EtanolRESUMEN
Quinze pacientes portadores de cirrose hepática e hipertensao portal e HCV-RNA detectado no sangue circulante pela técnica da reaçao de polimerizaçao, receberam ribavirina 1 g/dia por um período de seis meses, em um estudo nao controlado. Dos pacientes inicialmente selecionados, dois apresentaram complicaçoes da doença de base e nao tiveram seus dados computados no final do estudo. Quatro pacientes apresentaram como complicaçao da terapia, queda dos níveis de hemoglobina superior a 20 por cento dos valores iniciais e em um paciente foi necessário reduzir a dose do medicamento. Praticamente todos pacientes apresentaram algum grau de reduçao dos níveis das aminotransferases, especialmente ao final do terceiro mês de tratamento quando foi observadas uma reduçao significante dos níveis de AST e ALT em relaçao ao início do estudo. Ao final do tratamento, quatro pacientes apresentaram resposta completa, com normalizaçao das aminoistranferases. Destes, apenas um paciente apresentou negativaçao do HCV-RNA, mais a interrupçao da droga foi seguida de pronta elevaçao das enzimas e positividade do HCV-RNA. Estes resultados indicam que apesar de bem tolerado e de induzir a uma reduçao transitória dos níveis das aminotransferases, o uso isolado de ribavirina nao parece ser capaz de erradicar a infecçao pelo vírus C em pacientes com cirrose hepática e hipertensao portal.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Cirrosis Hepática/tratamiento farmacológico , Hepatitis C/complicaciones , Ribavirina/uso terapéutico , Alanina Transaminasa/sangre , Análisis de Varianza , Aspartato Aminotransferasas/sangre , Cirrosis Hepática/etiología , Hemoglobinas/análisis , Hepacivirus/efectos de los fármacos , Hipertensión Portal/complicaciones , ARN Viral/análisisRESUMEN
Os valores séricos de magnésio obtidos por método colorimétrico automatizado foram avaliados em 31 pacientes portadores de cirrose de etiologia alcoólica com hipertensäo portal e que näo faziam uso de diuréticos de alça e correlacionados com a avaliaçäo clínica, bioquímica e nutricional e os valores séricos de cálcio, fósforo, potássio e zinco. A avaliaçäo antropométrica foi feita pela medida da prega cutânea tricipal (PCT), circunferência do braço (CB) e circunferência muscular do braço (CMB). Dos pacientes avaliados, 16 apresentavam valores de magnésio estavam reduzidos em 20 por cento ou mais. Hipocalcemia e hipopotassemia foram observadas em apenas um paciente, cada uma. Hipofosfatemia e reduçäo do zinco sérico foram observadas em dois pacientes. Foram detectadas significantes associaçöes entre a hipomagnesemia e menor tempo de abstinência alcoólica, medidas antropométricas da CB e da CMB, o nível de albuminemia e o grau de disfunçäo hepática medido pela classificaçäo de Child-Pugh. Isoladamente, os valores de CMB se correlacionaram significativamente com os níveis de magnésio (r=0,51p<0,01). Estes resultados sugerem que, mesmo em cirróticos alcoólicos que näo estejam utilizando diuréticos de alça, a hipomagnesemia leve e moderada seja frequente e que a desnutriçäo, a disfunçäo hepática avançada e o alcoolismo estejam associados aos baixos valores séricos deste íon
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Humanos , Masculino , Femenino , Cirrosis Hepática Alcohólica/sangre , Magnesio/sangre , Evaluación Nutricional , Estado Nutricional , Análisis de Varianza , Distribución de Chi-Cuadrado , Cirrosis Hepática Alcohólica/complicaciones , Tiempo de ProtrombinaRESUMEN
A doença hepática gordurosa não alcoólica representa uma das mais importantes doenças do fígado em todo mundo. No Brasil ainda não dispomos de nenhum dado sobre sua prevalência na população geral. Neste trabalho, faz-se uma análise retrospectiva sobre a prevalência de esteatose ao ultra-som de abdome, em 9.340 exames realizados em pacientes externos no serviço de ultra-sonografia do Hospital Sório_Libanês de São Paulo.Nessa casuística a prevalência global de esteatose foi de 19,2por cemto, sendo o único achado ultrasonográfico em 48por cento dos pacientes examinados. Esses achados apontam para elevada prevalênacia de esteatose em nosso meio, semelhante à observada em países da Europa e do Oriente
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Abdomen , Hígado Graso/diagnóstico , Hígado Graso , Prevalencia , Estudios RetrospectivosRESUMEN
A peritonite bacteriana espontânea (PBE) é uma freqüente e grave complicaçäo da ascite de portadores de cirrose hepática. Este trabalho apresenta um estudo comparativo sobre a sensibilidade de três diferentes métodos de cultura para o isolamento de bactérias em pacientes com ascite neutrofílica. Foram estudados 32 pacientes portadores de ascite neurotrofílica detectada dentro de 24h de admissäo hospitalar. O líquido colhido através de paracentese foi levado ao laboratório em frasco estéril para semeadura ou inoculado à beira do leito em frascos de hemocultura convencional (Hemobacâ) e em Bactec Ped Plusâ. Dos 32 pacientes, 43,75 por cento apresentaram cultura positiva. A inoculaçäo à beira do leito quer em Bactec Ped Plus (37,5 por cento) quer em Hemobac (37,4 por cento) apresentou maior positividade que a cultura convencional (25 por cento), além de maior rapidez na identificaçäo do crescimento bacteriano. Elevado nível de concordância foi observado para a inoculaçäo em Bactec Ped Plus e em Hemobac.
Asunto(s)
Humanos , Adolescente , Adulto , Persona de Mediana Edad , Ascitis/complicaciones , Ascitis/microbiología , Cirrosis Hepática/complicaciones , Medios de Cultivo , Líquido Ascítico/microbiología , Peritonitis/etiología , Sensibilidad y EspecificidadRESUMEN
É apresentado um caso de síndrome de Budd-Chiari associado a policitemia vera, em que foi indicado o transplante ortóptico do fígado. Após revisao da literatura acerca da etiologia e terapêutica dessa associaçao, discutem-se os fatores que devem influenciar a decisao a ser tomada entre um transplante de fígado ou uma derivaçao venosa.